S E Byrne1, A J Rothschild. 1. Department of Internal Medicine, Cambridge Hospital, Mass, USA.
Abstract
BACKGROUND: Many patients with unipolar depression experience a return of depressive symptoms while taking a constant maintenance dose of an antidepressant. METHOD: All cited studies were found using computerized literature searches of the MEDLINE database since 1966. RESULTS: The return of depressive symptoms during maintenance antidepressant treatment has occurred in 9% to 57% of patients in published trials. Possible explanations include loss of placebo effect, pharmacologic tolerance, increase in disease severity, change in disease pathogenesis, the accumulation of a detrimental metabolite, unrecognized rapid cycling, and prophylactic inefficacy. CONCLUSION: Although several strategies have been proposed to overcome the loss of antidepressant efficacy, double-blind controlled studies are needed to ascertain the optimal strategy for this perplexing clinical problem.
BACKGROUND: Many patients with unipolar depression experience a return of depressive symptoms while taking a constant maintenance dose of an antidepressant. METHOD: All cited studies were found using computerized literature searches of the MEDLINE database since 1966. RESULTS: The return of depressive symptoms during maintenance antidepressant treatment has occurred in 9% to 57% of patients in published trials. Possible explanations include loss of placebo effect, pharmacologic tolerance, increase in disease severity, change in disease pathogenesis, the accumulation of a detrimental metabolite, unrecognized rapid cycling, and prophylactic inefficacy. CONCLUSION: Although several strategies have been proposed to overcome the loss of antidepressant efficacy, double-blind controlled studies are needed to ascertain the optimal strategy for this perplexing clinical problem.
Authors: Anthony J Rothschild; Boadie W Dunlop; David L Dunner; Edward S Friedman; Alan Gelenberg; Peter Holland; James H Kocsis; Susan G Kornstein; Richard Shelton; Madhukar H Trivedi; John M Zajecka; Corey Goldstein; Michael E Thase; Ron Pedersen; Martin B Keller Journal: Psychopharmacol Bull Date: 2009
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